REOCC-03-24-568 126 NW 107 StMiami Shores Village MAR 08 M4
Building Department -- 4
10050 N.E.2nd Avenue, Miami Shores, Florida 33138
Tel: (305) 795.2204 Fax: (305) 756.8972
INSPECTION'S PHONE NUMBER: (305) 762.4949
RE -OCCUPANCY Permit No.'LUCC - b3 -2-.4 -
APPLICATION BYco� ��'���� �► h asl Yl w o Yl�-4-
Contact Name: Jesus Verduzco Phone#: 510-603-9755
Buyer: Danny Pirajan Seller: J Verduzco Investments LLC
Realtor: Pattaraporn Karnjanasiriwan Company Name: Julie's Realty, LLC
Property Address: 126 NW 107th Street
City: Miami Shores State: Florida Zip: 33168
I hereby certify that I understand that the zoning for this property is for single-family residential use and that it
is unlawful for more than one family to reside therein. I also understand that any Certificate of Re -Occupancy
that may be issued by Miami Shores Village certifies only that the referenced property is being used for single
family purposes and that such certificate does not constitute any representation, warranty or certification as to
the condition of the dwelling or other structures on the property.
APPLICANT'S AFFIDAVIT: I certify that all the foregoing information is accurate.
J Verduzco Investments LLC/Jesus Verduzco
Applicant Name:
Signature:
i
The foregoing instrument was acknowledged before me this
day of �, 20 Z4 by -SQSUS 'a (duZC0
who is ersonally known to me r who has produced
As iden i 'cation and who did take an oath
NOTARY PUBLIC:
Sign:
Print: U-1' nc1 coA (- -2 a&CoQ
My Commission Expires:
Building Officials Approval:
V /
d� /1'
REV 4-10
E4og:01) =Statete of FloridaH 15304625
Re-Occ $60.00
Notary-.
Total $ t O • 15'0